Robert R.

Robert R. (early 1954 – May 15 [cite news
last = Gorman
first = Christine
coauthors =
title = Strange Trip Back to the Future
work =
pages =
language = English
publisher = "Time"
date = November 9, 1987
url = http://www.time.com/time/magazine/article/0,9171,965934-1,00.html
accessdate = 2007-11-24 ] or 16 [cite news
last = Crewdson
first = John
coauthors =
title = Case Shakes Theories of AIDS Origin
work =
pages =
language = English
publisher = "Chicago Tribune"
date = October 25, 1987
url = http://www.aegis.com/news/ct/1987/CT871003.html
accessdate = 2007-11-24 ] , 1969) was an African-American Missouri teenager who was the victim of the first confirmed case of HIV/AIDS in North America.

His death at the age of 15 baffled doctors, and not until 1984 was the cause of his death identified.

Illness

In late 1968, Robert R. (whose last name has been kept confidential) admitted himself to the Barnes-Jewish Hospital (then called the Barnes Hospital) in St. Louis, Missouri. His legs and genitals were covered in warts and sores, and Robert also had grown thin and pale, and suffered from shortness of breath. Robert told the doctors that he'd suffered symptoms since at least late 1966, and tests discovered a severe Chlamydia infection. Robert explicitly declined a rectal examination request from hospital personnel. Robert said he was sexually active with a girl from his neighborhood, but doctors suspected he was homosexual or bisexual.

In early 1969, Robert's condition seemed to have stabilized, but by March his symptoms reappeared, and had worsened. He had more trouble breathing and his white blood cell count had plummeted. The doctors found that his immune system had somehow ceased to function. He developed a fever and died on either May 15 or 16, 1969.

Autopsy

On the day of Robert's death, an autopsy uncovered several abnormalities. The autopsy, led by Dr. William Drake, revealed small purplish lesions on Robert's left thigh and his soft tissue. Drake concluded that the lesions were Kaposi's sarcoma, a rare type of cancer that, up to that time, mostly affected elderly Jewish and Italian men. Kaposi's sarcoma, if found in those under the age of sixty, was later recognized as a symptom of AIDS if and only if a person is HIV positive. The sarcomas were also found in Robert's rectum and anus, which had never occurred in previous cases.

This baffled the doctors, and a review of Robert's case was eventually published in a medical journal in 1973. After the autopsy, some of his remains were kept in cold storage at facilities at the University of Arizona and at the laboratory of Dr. Memory Elvin-Lewis, who had assisted in Robert's autopsy.

Tests

In 1984, three years after AIDS was officially discovered and had started spreading at dangerous levels in New York City and Los Angeles, Dr. Marlys Witte, one of the doctors who, like Elvin-Lewis, had looked after Robert and also assisted in the autopsy, thawed and tested preserved samples of Robert's remains. In the remains were found antibodies to Herpes simplex, cytomegalovirus, and Epstein-Barr virus, three diseases common among homosexual men, especially those with AIDS. Five years later, in June 1989, Witte decided to test Robert's remains again using more recent technology, settling on western blot, one of the most powerful antibody-detection tools available at the time. The western blot found that all nine HIV proteins were present in Robert's blood. A second test was done, showing the same results.

Impact on AIDS origin research

Robert had never traveled outside of the United States and, indeed, never left the midwest, and had told doctors that he had never received a blood transfusion. Since Robert's infection was almost certainly through sexual contact and he had never left the country, it is obvious that he must have received the virus from somebody else already living with it in the United States, meaning that AIDS was present in North America before he began showing symptoms in 1966. He also did not contract it in any of the areas which currently have large numbers of AIDS cases, like San Francisco and New York. [ [http://query.nytimes.com/gst/fullpage.html?res=9B0DEFD6173AF93BA15753C1A961948260&sec=health&pagewanted=all] ]

In his 1999 book "The River", journalist and controversial AIDS researcher Edward Hooper questioned whether Robert really died from AIDS. Hooper noted that Robert's grandfather had reportedly suffered from similar symptoms (suggesting a congenital immunodeficiency) and that he may have been exposed to toxins in his childhood. Robert's symptoms, moreover, were (with the exception of his Kaposi's sarcoma) not wholly typical of AIDS patients. Hooper also noted that Robert's sexual history may have been more prosaic than suspected, and reported that one apparent sexual partner of Robert's was still alive decades later. Hooper also notes that the HIV testing carried out may have used a technique (a sensitivity-enhanced form of the Western blot test developed by Biotech) known to generate false positives.

See also

*Arvid Noe
*Index case (medicine)
*Timeline of early AIDS cases

References

External links

* [http://www.time.com/time/magazine/article/0,9171,965934-1,00.html TIME magazine from 1987 detailing the Robert R. case]
* [http://www.aegis.com/news/ct/1987/CT871003.html AEGiS article – Case Shakes Theories of AIDS origin]
* [http://query.nytimes.com/gst/fullpage.html?res=9B0DEFD6173AF93BA15753C1A961948260&sec=health&pagewanted=all NY Times "BOY'S 1969 DEATH SUGGESTS AIDS INVADED U.S. SEVERAL TIMES" 1987]